Subzonal insemination (SUZI) has been proposed for patients with severe male factor and previous fertilization failure. However, very low fertilization rates still persisted. The aims of this study were firstly, to examine the relationships
between
the
fertilization rate and sperm parmeters, sperm incubation media and time, secondly, to evaluate the outcome of 119 cycles of SUZI applied the modified sperm preparation method. The fertilization rates were influenced more sensitively by sperm
preincubation media and time than by sperm parameters. According to preincubation media and time, the fertilization rates were 43.3% in 50% follicular fluid (HFF), 36.6% in 10% fetal cord serum (FCS), and with the time, increased in FCS, but
decreased
in HFF. In regrd with sperm parameters, the fertilization rates were 42.9% in normal and 37.6% in subnormal group. The best results were obtained from SUZI by the spermatozoa incubated in 50% HFF for 6-8 hours. So we tried 119 cycles of SUZI
(normal; 39
cycles, subnormal; 80 cycles) using the preparation method of 6-8 hour incubation in 50% HFF. There were no significant differences in the fertilization rates between normal (125/269, 46.4%) and subnormal sperm (264/635, 41.6%). Contrary to the
fertilization rates, pregnancy outcomes were different between both groups. Better results obtained from the subnormal group than the normal in the number of transferred embryos, that of good embryos, and developmental rate of the fertilized
eggs.
The
pregnancy rates per transfer were totally 13.3% (13/98), 20.0% (13/65) in subnormal group. In the normal group, 2 patients showed β-hCG positive, but resulted in chemical pregnancy. Of 13 clinical pregnancies, two aborted, 6 on-going, and 5
delivered.
In conclusion, SUZI is an effective technique to overcome fertilization failure for male factor and unexplained. The fertilization rate is influenced by sperm parameters, sperm incubation media and time. Also the quality of oocytes might be
important
for pregnancy as same as that of sperm.
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